The Australian Commission on Safety and Quality in Health Care (ACSQHC) has released a report evaluating antimicrobial resistance trends in Australia. This report provides an analysis of 2016 data collected by the Australian Group on Antimicrobial Resistance (AGAR).

One of the key findings relates to the increasing level of antimicrobial resistance among Escherichia coli. This facultatively anaerobic coliform bacterium is commonly found in the intestines of people and animals. While many strains are harmless, pathogenic strains are often associated with infections of the gastrointestinal tract and urinary tract. More serious cases can lead to sepsis, with E. coli responsible for 36.8% of bacteraemia cases reported in Australia.

The AGAR data demonstrates a steady increase in the non-susceptibility of E. coli to key antimicrobials such as ceftriaxone, ceftazidime, cefepime, ciprofloxacin, trimethoprim, and amikacin. Extended-spectrum β-lactamase (ESBL) phenotypes are now found in an average of 12.7% of E. coli isolates. The incidence is highest in New South Wales at 16.1% and lowest in Tasmania at 7.1%. This increase is in line with global trends and is thought to be due to cross-resistance and co-resistance to antimicrobials used in the community. The increasing incidence of ESBLs is significant as this limits the usefulness of third-generation cephalosporins.

Potential consequences of this increased resistance among E. coli include initial treatment failure and unnecessary hospitalisations due to the absence of effective oral agents. This has significant implications for healthcare providers and the public. However, the report does offer some good news as the rate of carbapenemase-producing E. coli remains low at <0.1%. Carbapenems are often thought of as antimicrobials of last resort for the treatment of severe infection. The ACSQHCpublish a set of recommendations that can be consulted to help prevent, detect, and contain carbapenemase-producing Enterobacteriaceae (CPE) in acute care health facilities.

References:

  1. Australian Commission on Safety and Quality in Health Care. Recommendations for the control of carbapenemase-producing Enterobacteriaceae (CPE). A guide for acute care health facilities. Sydney: ACSQHC, 2017.
  2. Coombs G, Bell JM, Daley D, Collignon P, Cooley L, Gottlieb T, et al. Australian Group on Antimicrobial Resistance. Sepsis Outcome Programs 2016 Report. Sydney: Australian Commission on Safety and Quality in Health Care; 2018.

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